Healthcare Provider Details

I. General information

NPI: 1790460798
Provider Name (Legal Business Name): J&S DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 5TH AVE LBBY 3
NEW YORK NY
10011-8858
US

IV. Provider business mailing address

24 5TH AVE LBBY 3
NEW YORK NY
10011-8858
US

V. Phone/Fax

Practice location:
  • Phone: 347-536-9017
  • Fax:
Mailing address:
  • Phone: 212-989-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JINKYU IM
Title or Position: OWNER
Credential: DDS
Phone: 347-536-9017